Breast Cancer Risk with Breast Cancer Risk with Menopausal Hormone Menopausal Hormone

UseUseJackie BouillonJackie Bouillon

Advisor: Dr. Robert HadleyAdvisor: Dr. Robert Hadley

Spring 2007Spring 2007

The HRT ControversyThe HRT Controversy

HRT was standard of therapy for HRT was standard of therapy for menopausal symptoms for yearsmenopausal symptoms for years

In early 2000’s positive view of HRT In early 2000’s positive view of HRT was changed with the results of WHI was changed with the results of WHI and HERS studiesand HERS studies Showed association between HRT and Showed association between HRT and

increased risk for breast cancer, heart increased risk for breast cancer, heart attack, stroke attack, stroke

Summary of HRT and Summary of HRT and Factors Associated with Factors Associated with

Breast CancerBreast Cancer Factors leading to Factors leading to

worse prognosisworse prognosis Adiposity Adiposity Smaller body size and Smaller body size and

HRT useHRT use Long term unopposed Long term unopposed

estrogen use (>15 yrs)estrogen use (>15 yrs) Combined estrogen-Combined estrogen-

progesterone progesterone regimensregimens

Positive hormone Positive hormone tumor status tumor status (ER+/PR+)(ER+/PR+)

Higher tumor gradeHigher tumor grade

Factors that do not Factors that do not lead to worse lead to worse prognosisprognosis HRT use if HRT use if

overweight (no overweight (no additional increased additional increased risk)risk)

Short-term Short-term unopposed estrogen unopposed estrogen use (<15 yrs)use (<15 yrs)

Negative hormone Negative hormone receptor tumor status receptor tumor status (ER+/PR- or ER-/PR-)(ER+/PR- or ER-/PR-)

HRT After Breast CancerHRT After Breast Cancer

What about HRT for women with a history What about HRT for women with a history of breast cancer?of breast cancer? Very controversial issueVery controversial issue Typically HRT is avoided by women with prior Typically HRT is avoided by women with prior

breast cancer diagnosis for fear of recurrencebreast cancer diagnosis for fear of recurrence

Most observational studies suggest that Most observational studies suggest that HRT does NOT increase breast cancer HRT does NOT increase breast cancer recurrence and mortality in women with a recurrence and mortality in women with a prior diagnosisprior diagnosis

HRT After Breast CancerHRT After Breast Cancer

First 2 randomized controlled trials First 2 randomized controlled trials were stopped prematurely after were stopped prematurely after showing an increase in recurrence showing an increase in recurrence with HRT usewith HRT use HABITS Trial: rate of recurrence HABITS Trial: rate of recurrence

significantly higher with HRT usesignificantly higher with HRT use Stockholm Trial: no associated increase Stockholm Trial: no associated increase

in recurrence with HRT usein recurrence with HRT use

Why the Disparity in the Why the Disparity in the Results?Results?

HABITS TrialHABITS Trial Participants had Participants had

higher grade lymph higher grade lymph node involvementnode involvement

Majority of women Majority of women used combined used combined HRT; small HRT; small percentage used percentage used unopposed unopposed estrogenestrogen

Stockholm TrialStockholm Trial Participants had Participants had

lower grade lymph lower grade lymph node involvementnode involvement

Majority of women Majority of women used unopposed used unopposed estrogen or estrogen or combined in which combined in which progesterone was progesterone was taken for short taken for short intervalsintervals

ConclusionsConclusions

More clinical trials needed before can More clinical trials needed before can make conclusions about HRT after make conclusions about HRT after breast cancerbreast cancer

Providers need to be aware of the factors Providers need to be aware of the factors associated with increased breast cancer associated with increased breast cancer risk risk

Providers need to work with each patient Providers need to work with each patient individually to assess her need for HRT individually to assess her need for HRT and risk factors to determine if HRT is and risk factors to determine if HRT is appropriateappropriate